MNT mastication, swallowing and nutrition absorption disorders/mental health/HIV/Dermatology Flashcards
Mastication, swallowing and Nutrition absorption disorders -Dysphagia
A. Dysphagia or difficult swallowing caused by many disorders
B. Can lead to weight loss and nutritional deficiencies due to inadequate dietary intake
c. Intervention:
-monitor weight, nutritional parameters and hydration
-reduction of dietary fat intake
-use of small meals
-diets low in calorie density
-limit alcohol consumption
-mild exercise
-emotional support and stress reduction
MSNA-Achalasia
a. Disorder of motility characterized by weakened peristalsis or an absence of peristalsis in esophagus
b. Accompanied by increased LES presence
c. Patient experience dysphagia, vomiting and pain on swallowing
d. Can lead to insufficient dietary intake and subsequent weight loss
e. Intervention
-modification to texture of foods in the diet
-increasing nutrient density (caloric and protein)
-smaller and more frequent meals
-avoid spicy and hot foods to prevent esophageal damage.
Malabsorption
-Absorption disorders- may occur by changes in mastication, motility and permeability function.
-Often originates form genetic polymorphism, post translational error or enzyme kinetic issues.
-Malabsorption refers to the malabsorption of fat, carbohydrate or protein due to maldigestion or from anatomical /physiological damage to the small intestine.
-Several disease states can lead to malabsoprtion, including, but not limited to celiac disease and crohn’s disease
-Dysfunctions of the accessory disorders (liver, gallbladder) can cause/contribute to malabsorption.
-Decreased transit time as occurs in diarrhea, or from anatomical changes secondary to surgery can lead to maldigestion or malabsorption.
-Malabsorption can lead to decreased villous height, decreased enzyme production, or deficient enterocyte production (recall the functions of the brush border in the section on the anatomy & physiology of the lower GI tract).
-It leads to immune, hormonal or inflammatory imbalance.
-Causes: gut irritability-leaky gut, food allergies, bacterial or yeast overgrowth.
Malabsorption
inadequate assimilation of dietary substances due to defects in digestion, absorption or transport.
-causes:
a. celiac disease- impairs the absorption of most nutrients, vitamins, and trace minerals results in global malabsorption or selective mal absorption (pernicious anemia)
b. Pancreatic insufficiency- >90 function lost
-Zollinger-Ellison syndrome (increased luminal acidity) inhibits lipase and fat digestion.
-Cirrhosis and cholestasis-reduce hepatic bile synthesis or delivery of bile salts to duodenum causing malabsorption
-Acute ciral, bacterial and parasitic infections- cause transient malabsorption due to superficial damage to villi and microvilli
-Use of vitamin B12 and other nutrients by intestinal bacteria may interfere with enzyme systems and cause mucosal injury
Fat malabsorption (Steatorrhea)
Carbohydrate malabsorption
Protein malabsorption
A. malabsorption of fat soluble vitamins + potentially excess oxalate.
b. fat malabsoprtion reduce normal excretion of oxalate.
c. excess oxalate–Kidney stomes, urolithiasis, hyperoxaluria
d. symptoms of fat malabsorption: abdominal pain, cramping, diarrhea
Carbohydrate malabsorption: lactose malabsorption (lactose intolerances
a. symptoms: increased gas, abdominal cramping, diarrhea
Protein malabsorption: protein losing enteropathy caused by other diseases
a. reduce protein – reduce oncotic pressure–peripheral edema.
Nutrition absorption disorders
Inadequate gastric mixing, rapid emptying:
a. Cause: Billroth II gastrectomy
b. Gastrocolic fistula
c. Gastroenterostomy
Insufficient digestive agents: Biliary obstruction and cholestasis.
cirrhosis
chronic pancreatitis
cholestyramine- induced bile acid lose
cystic fibrosis
lactase deficiency
pancreatic cancer
pancreatic resection
sucrase-isomaltase deficiency
abnormal milieu:
Abnormal motility secondary to diabetes, scleroderma, hypothyroidism
MNT Malabsorption
A. DetectionL careful and thorough nutritional assessment. Such an assessment is very important as long term malabsorption can have a wide array of deleterious effects.
B .Include the use of substitutions for the lost macronutrient and associated micronutrients, but should also address the underlying cause of malabsorption wherever possible.
C. Natural medicine can be particularly well suited to this task with both a wide array of functional GI testing, but also with a wide range of therapeutics to repair and restore GI health (glutamine, slippery elm…)
Dermatological disorders-Acne
Acne occurs in three forms:
a. acne vulgaris
b. acne conglobata
c. acne rosacea
Acne vulgaris: fomration of comedones, palpules, pustules, nodules, and/or cysts as a result of obstruction and inflammation of pilosebaceous units (hair follicle and their accompanying sebaceous gland)
Factors causing acne
a. excess sebum production
b. follicular plugging with sebum and keratinocytes
c. colonization of follicles by propionibacterium acnes
d. Release of multiple inflammatory mediators
Causes:
A. puberty- surges in androgen stimulate sebum prodcutionand hyperproliferation of keratinocytes.
B. Hormonal changes that occur with pregnancy or the menstrual cycle
c. occlusive cosmetics, cleanser, lotions, clothing
d. high humidity and sweating
MNT:
a. Outbreaks may be prevented or their severity minimized by avoidance of sugar, fried food, milk, and iodine
b. Benefit may be obtained from supplementation with chromium, vitamin A, Vitamin E, selenium, zinc
HIV/AIDS
-HIV is a virus that targets host cells and turns them into viral factories for HIV reproduction.
-AIDS is a symptomatic condition that results from HIV infection and which makes the individual vulnerable to opportunistic infections that can cause disability or death.
- Production of acute phase proteins can negatively impact nutritional status.
-Micronutrient changes: lower levels of selenium, zinc, choline, glutathione, vitamin A, B6, B12 and E in the serum.
-Elevations of folate, niacin, and carnitine may also be present.
-lower levels of vitamin C & E can contribute to oxidative stress.
Goals of MNT
-USe of nutrtion inteventions to prevent weight loss, improve caloric intake and/or symptoms. CD-4 counts and quality of life.
-50-80% of patients experience some form of malnutrition resulting from alterations in nutrient intake, absorption and metabolism.
-muscle wasting is common and mortality is closely realted to weight loss.
-Nutritional support:
a. can improve nutrtional status
b. repletion of body cell mass and functional improvement
Immune system is impaired by malnutrition and HIV infection. Cause altered metabolism, inadequate dietary intake, malabsorption, further impair immune system and contribute to muscle wasting.
MNT HIV
-Early nutritional assessment- attention to nutritional requirements to prevent muscle wasting and replace body cell mass.
-Daily protein intake- 2 g/kg of body weight
-Daily use of MVM– reduce risk of declining CD+4 T-lymphocyte counts. extends the latency period of the development of overt disease by years
-HIV Infected and AIDS patients have elevated levels of oxidative stress – antioxidant supplementation.
-Reported benefits : beta carotene induced increased in the number of circulating CD4+ helper T Lymphocytes, leukocytes, B Lymphocytes.
Glutathione and N-acetylcysteine reduce oxidative stress, extend latency period of the onset of symptoms, and inhibit HIV replication.
Supplemental antioxidants reduce oxidative stress and accelerate cellular apoptosis.
Mental Health/Mood Disorders
A Mental/mood disorder etiology
a. genetic predisposition
b. poor nutritional intake
c. imbalance of omega 3, omega 6 fatty acid
c. external triggers such as drug use/stress
B. Examples of disorders
a. depression
b. andiety disorder
c. attention deficient disorder
d. bipolar
e. acute stress/post traumatic stress disorders
Neurochemical changes
-production of fewer neurotransmitters
-altered neurotransmitter levels
-changes in neurotransmitter receptor density
Nutrition assessment
A. BMI evaluation
B. Dietary assessment for
a. fatty acids
b. antioxidants and phytochemicals
c. excessive processed foods
d. excessive refined carbohydrates
Mental Health/Mood disorders MNT
-omega 3 fatty acids (EPA + DHA)
a. consume fish two times/week
b. mood disorders: 1-9 g/day above 3 mg should be monitor by physicians
c. minimum 1 g/day recommended
-Vitamin D
-B complex vitamins
-Phytochemicals
-antioxidants
-weight management
-sleep
-exercise
-stress management
